National Kidney Foundation of Hawaii

Maui Office
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For Car Donation Instructions,

Click HERE

For an example of where to sign the Title,

Click HERE

National Kidney Foundation of Hawaii : Oahu - Online Car Form

Oahu - Online Car Form

Internet Car Donation Form:

Primary Donor Information:

(The primary donor is the person who's Tax ID # will be used when filing an IRS Itemized Tax Form. This person's name must be listed as an owner on the Certificate of Title)

Last Name:
First Name:

Address Information:
	(Street) (Apt/Unit #)

City:
State:
Zip Code
Email Address:
Primary Contact Phone #:
Secondary Contact Phone #:
Name/Names on Title:
VIN #:
License Plate #:

Please tell us why you are donating your vehicle:
Primary:
Secondary:

Please tell us how you heard about Kidney Cars:
Primary:
Secondary:

Please tell us how you found our website:
Primary:
Secondary:

Vehicle Information

Year:

Make:

Model:

Type:

Color:

(choose the one that best applies)

Transmission:

Cylinders:

Vehicle currently drivable:

Registration Expiration Date:

Safety Expiration Date:

Odometer Reading:

Is the odometer NON-working:

Please check all the boxes below that apply

Has the odometer turned over:

Is this the actual miles:

Vehicle was in an accident and not repaired:

Is the title marked as "Salvaged":

Are your plates in storage:

Does the vehicle have specialty plates:

If yes, please exchange at the DMV before donating.

Does the vehicle have military or parking stickers:

if yes please remove before donating

Repairs: Please check YES to all the repairs needed below

(At least one box must be checked)

Head gasket	Transmission	Radiator
Brakes	Major body damage	Timing belt
Fuel system	Water pump	Engine leaks
Electrical issues	Ignition/Starter	Crack/Chips in glass
Unsure	Other	None

Accessories: Please check all the boxes below that apply

Power Steering		works
Power Windows		works
Power Locks		works
Alarm System		works

Sound System: Please check all the boxes below that apply

None
Radio		works
Cassette		works
CD		works

Car Condition Information: Please rate your vehicle on a scale from 1 - 5

with 5 being the best (like new) condition

Battery:

Transmission:

Engine:

Tires:

Air Conditioner:

If the A/C is broken, does it blow warm air?

Please answer yes if it does.

Paint

Rust:

Seating Surface:

Interior:

Overall Car Condition

Car Location Information

	Option 1:
	Free Towing/Pick-Up Service
		Check here if address is the same as the Donor Information Address
	Address:					Stall#
	Zip Code				Date ready for pick up:
	•	If the vehicle is not accessible to the tow company on the agreed-upon dates and location, you will be charged for the Dry-Run Fee ($50) prior to having a second tow truck dispatched.


		Contact Person
		Contact Phone #

If your vehicle is being picked up from a service station and parts are missing when tow truck arrives, your car will be rejected. Please ask mechanics/service station personnel to leave your car totally intact.


	What hours of the day/night will you permit the tow company to tow your car?
				My doors will be		(We recommend locking your vehicle)
				My keys will be left
	Will you permit the tow truck drivers to drive your car? (they are insured)

	Does the Contact Person want to be present during towing?					(If yes, may take longer to tow)
	Does the Contact Person want a call before pick up?
	Can we leave a message and tow?
	Are all four tires fully inflated?
	Is the car on a steep incline?
	Is your car on pavement?					If No-will need to be moved prior to towing
	Is the car at least 4 feet from any structures?

	Option 2:
	Drop Off at the National Kidney Foundation of Hawaii Office Building (ONLY DURING OFFICE HOURS) *Must be approved prior to Drop Off
	•	Address:	1314 South King Street # 305
	•	Drop Off Hours: Monday thru Friday 8:30-4:30 and Saturday 9:00-3:00
	•	Park in Visitor Parking
		- Write Stall # and last Odometer Reading on parking ticket bring to office with car keys
	•	Required Documents
		1.	Completed NKFH Car Donation Forms (Hard Copy or Online Forms)
		2.	Signed Title and Notice of Transfer
		3.	CURRENT REGISTRATION AND SAFETY CHECK

	Option 3:
	Drop Off at Manheim Aloha Auto Auction in Mapunapuna *Must be approved prior to Drop Off
	(Please call 596-7575 to make a drop off appointment)
	•	Address:	1001 Ahua Street
	•	Drop Off Hours: Monday thru Thursday 8:30-4:30 and Friday 8:30-1:30
	•	Required Documents
		1.	Completed NKFH Car Donation Forms (Hard Copy or Online Forms)
		2.	Signed Title and Notice of Transfer
		3.	CURRENT REGISTRATION AND SAFETY CHECK

Disclosure Agreement

I have donated my vehicle to the National Kidney Foundation of Hawaii (NKFH). I release ownership with the understanding that the vehicle will be sold to raise funds to fight kidney disease in Hawaii. My vehicle meets the minimum acceptance requirements below:

1. The complete engine, transmission and parts are on the vehicle, attached, and in their proper place*;
2. The wheels are not locked and will not be removed after donation;
3. The vehicle has never been on fire, had flood damage or been submerged in water and isn't located where it has partially sunk into the ground due to mud.

4. There are no additional engine parts, trash, furniture or items inside the vehicle;

My car is being donated free of any unpaid violations, fines or liens (including tow charges associated with the theft of my car) and will remain so prior to NKFH taking physical possession of it. If I am asking NKFH to tow my vehicle, I understand that the following conditions apply:

1. NKFH may require up to five working days after receiving my properly signed title in which to tow my vehicle.
2. If my vehicle is cited or removed prior to NKFH’s tow, I understand that NKFH will not tow my vehicle until I pay all fees including a NKFH assessed Dry-Run Fee for Non-Pick Up.
3. I understand that if my vehicle is not accessible to the tow company on the agreed-upon dates and location, I must pay for the dry-run fee prior to having a second tow truck dispatched.
4. The car must have a minimum of four feet of clearance on all sides,
5. The car must be on pavement or cement. (Tow companies are prohibited from physically pushing vehicles to a place where it will be accessible).

I understand that if the DMV mails me a citation for an offense occurring after donation, NKFH will clear the citation. I understand that any parking decals or personal belongings left in or on my vehicle will not be recoverable. If I have Veteran Plates or Specialty Plates, it is my responsibility to have them removed and assigned to a new vehicle or placed in storage at DMV prior to donation. I understand that if my vehicle is being picked-up from an auto repair shop, that it is my responsibility to ensure that no parts have been removed and that NKFH may refuse to tow my vehicle if parts have been removed.*
I understand that if I have gotten a duplicate title issued, I must give NKFH the most recently issued title. I must also give NKFH a transferable, Hawaii State, non-defaced title. If I cannot produce a transferable title, NKFH may reject my donation. In order to receive a tax benefit, I must itemize my taxes. I understand that if I have already depreciated the value of my vehicle or received an insurance settlement for its value, I may not qualify for a tax deduction. I hold harmless and agree not to pursue any legal action against NKFH, its board of directors or agents for any loss or liability that may be incurred as a result of my donation. NKFH reserves the final right to refuse the donation of any vehicle.
I understand that as of January 1, 2005, the maximum tax deduction I can receive without needing notification of the gross selling price (GSP) of my vehicle is $500. In order to claim a deduction above $500, NKFH must sell my vehicle for that amount (GSP). I understand that I will receive notification of my tax deduction within 30 days of the sale. NKFH cannot guarantee any selling price for any vehicle. It may take up to 60 days or longer to sell your vehicle and for you to receive notification of your tax deduction.

This letter also authorizes NKFH to pick up the following documents from DMV after donation, if needed: registration, title, certified copies of your notice of transfer (N.O.T) to NKFH

NoticeofTransfer (NOT)*For an example of where to sign the Title and NOT, Click HERE


My acknowledgement below indicates acceptance of NKFH regulations for this vehicle donation and any future vehicle donations which I may designate to the NKFH upon the deliverance of my properly signed title.


	I understand that my tax deduction per IRS Regulations may be the standard $500 Car Donation Tax Deduction.

	Today's Date

		I understand this agreement